Blood results are in... (Read 1956 times)

We runners are often at a disadvantage when it comes to diagnosing health issues and looking at blood work because our training is geared specifically to skew certain results to the abnormal end of the spectrum. This is what allows us to perform the way we do. We can have very low resting HRs, enlarged hearts, etc that without context can mean medical problems. This can create a great deal of confusion when getting healthcare and trying to diagnose problems. So I thought I'd share my experiences with iron deficiency over the years.
In 2003 I made my first attempt to qualify for the Olympic Trials. Honestly I started from too slow a starting point, and the training I needed to get from point A to B was just outside what I could handle. A couple months out from my target race I over-trained and DNF'd. Although I took significant easy time afterwards to recover, through the rest of 2003 and 2004 I could not train at a high level consistently. I would get tired, inexplicably have terrible workouts in the middle of otherwise decent training, under-perform at races, etc. In 2005 this got significantly worse, and by August of that year I threw in the towel and quit training for a few months and got blood work done.
The results came back and I was told I was not anemic. The head sports doctor for a top D-I collegiate program said this as well. However, looking at my test results, every measure related to iron and oxygen transport was either at the very low end of normal or below normal. Most notably, my ferretin level was only 12 (ferretin reflects the iron reserves in your blood).
The problem is that for the average American to present with anemia, they pretty much have to be passing out and light-headed all the time. This is not so for a serious or even moderately serious runner, who will notice such a problem long before due to them using the full potential of their oxygen transport on a regular basis. Additionally, "normal" is taken from an average population, not an athlete population. What may be fine for walking down the street may be seriously debilitating to a runner!
Ferretin is a case in point. I subsequently researched this further because, intuitively, if iron stores are low but hemaglobin/hematocrit are fine I did not see why it should be an issue -- it should not translate into problems until hemoglobin starts to fall. What I found, surprisingly, was a decent amount of data that in runners low ferretin does indeed have a significant impact on performance and expecially on recovery.
I started on heavy iron supplementation in September 2005. By December I felt like a whole other person, and by April 2006 I was taking 90sec off my 10K PR.
For the past several months I have again been trying to get back into serious training. I've encountered vaguely familiar feelings of fatigue, lack of endurance, and inability to finish workouts. I just got the bloodwork repeated. My ferretin is 41 -- higher than last time but still way on the low end of normal. Obviously if I were running my former 70-100 mpw it would be bottoming out but I'm only doing 60 mpw. My iron saturation is also way on the low end of normal. So back on the iron I go...strange, since I have plenty of iron in my diet already.
The moral of the study is that as a runner, recognize that you are different and you may need to work with your physician to get them to realize this and analyze the data correctly. Also understand the tests they are going to run (a ferretin level is not a standard part of the anemia panel, I had to specially ask for it).

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand

Hopefully this will do the trick, Andy
Sounds like there could be some kind of absorption problem if there is already plenty of iron in diet. Maybe that's another angle to attack it from besides just adding supplements.

I absolutely agree that anemia is ignored in runners way too often. I don't care for beef (in fact, the whole beef industry...ugh!), but I have been eating more of it in order to get more iron. And fresh spinach!

The moral of the study is that as a runner, recognize that you are different and you may need to work with your physician to get them to realize this and analyze the data correctly. Also understand the tests they are going to run (a ferretin level is not a standard part of the anemia panel, I had to specially ask for it).

Part of the problem with Ferritin levels is that the "normal" range is wide. My lab reports normal value range to be 10-232 ng/ml. Having someone who can analyze the data is so important.
Thanks for calling attention to this issue.
Best of luck to you

Life is not measured by the number of breaths we take, but by the number of moments that take our breath away...(unkown)

Very well stated, I agree. I would add this: the only way to know your body's iron store is to do a bone marrow biopsy and perform special tests on the sample you receive. All other tests are surrogates for the bone marrow biopsy. The hemoglobin tests most directly suggest your blood's oxygen carrying capacity, but as Spaniel points out, it is also the last to drop in a case of iron deficiency anemia. The ferritin and iron binding capacity tests are in the middle. They are not perfect either, and they are not commonly obtained until after the hemoglobin drops, but they can indicate iron deficiency early.
There is also an entity known as runner's anemia, which mimics iron deficiency anemia (but is not). The only way to distinguish the two is to do a bone marrow biopsy, although it is possible to stop running and see if your hemoglobin rebounds to normal.

ummm, ok so after this post went up, I decided to do a little sample on myself. Since I work in the lab, I stuck myself and decided to throw in a ferritin test while also checking on my cbc and cholesterol values. i often do a chol. check just to see how my weight loss is affecting my body (i love data, what can i say). but ive never done a ferritin before.....
so tonight, guess what? my freakin ferritin is only a 5! our range here is 8-388 so i was a little shocked to say the least. i usually always have crappy runs (only 1 out of 3 tend to be what i call "good") but ive always chalked it up to inexperience, and most recently just falling out of shape after a bout with itbs. but now i am left wondering if this level is part of my problem.
since my lab doesn't readily run the rest of the iron binding capacity tests and such, i will be sending my blood out to a reference lab to get these done (which will take a few days). i should also mention that my cbc was unremarkable - the hemoglobin and hematocrit being spot on. thanks for this post, otherwise i wouldve never guessed i might have the same problem. i will post back when i get an other testing resuts back.
trent - should i make a doc appt now? and what is this runner's anemia you had mentioned?

Trent...I, also, would be interested in understanding the runners anemia. What is it? What causes it? What to do about it. I do a decent amount of running. I started about 4.5 years ago. I lost 90 lbs in the first two years and the weight is still off. I feel run-down most of the time. I have chalked it up to lack of sleep and/or my sleep apnea. I do use CPAP every night. I have become vegetarian over the last 4 year period. Maybe something is missing from my diet.

Hopefully this will do the trick, Andy
Sounds like there could be some kind of absorption problem if there is already plenty of iron in diet. Maybe that's another angle to attack it from besides just adding supplements.

I agree that there could be some absorption issues. I developed anemia a few years ago and my doctor first asked me if I ran (which was a resounding no at the time) and then checked me for various issues that could cause absorption problems.
It is great to know that runner's anemia lurks out there, and reinforces my need to take iron myself (between being a runner and a celac, iron seems to always run low). Great thread!

'16 Goals:

Trent -
Please reply back with the runner's anemia explanation, I've never really heard of that one.
cewickbe -
That is the lowest ferretin reading I have come across. I'd see a doctor and ask about suplementation.
The funny thing that I cannot explain is that low ferretin seems to affect performance even if hemaglobin remains in the normal range. My N=1 experience and input from others with low ferretin seem to support this, but the data is slim at best. Last time my ferretin went back up with heavy supplementation and I ran great, even though my hemaglobin did not move much at all. All I can think is that the low stores hinder recovery somewhat or are an indicator linked to something else.
With me, there must be some sort of absorption issue but the doctor did not give any solution other than supplementation. It's worked before, I'm doing it again.

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand

Ooop. Just got back to town. Two long days on the road with a teething baby. Phew.
Runners' anemia can mimic and even be caused by iron deficiency. At this point, the only way to know for sure, especially with that ferritin, is to get a painful bone marrow biopsy or to start taking iron. You need to figure out why your iron is so low, if it is in fact low. Low iron is typically caused by inadequate intake over a long long time and/or chronic losses in the urine or GI tract. You need to have your urine and stool tested for blood. Since you are a woman, you also may need your uterus evaluated. Check with your doc.
Here is a nice case and discussion of runner's anemia:
http://jama.ama-assn.org/cgi/content/full/286/6/714"Runner's anemia is largely due to plasma volume expansion with elements of hemolysis, hemoglobinuria, and in long-distance runners, gastrointestinal blood loss."

spaniel, Best of luck to you this time around! At least now you know what the problem is and were able to take earlier action at the first onset of symptoms. Thanks for the informative post.
Are you going to try for the 2012 Olympic trials?

spaniel, Best of luck to you this time around! At least now you know what the problem is and were able to take earlier action at the first onset of symptoms. Thanks for the informative post.
Are you going to try for the 2012 Olympic trials?

No, I'm not going to try again. I have now pushed myself to the edge of what I could tolerate twice -- in 2004, resulting in maybe 2:23-2:25 conditioning, and again in 2006, maybe 2:20-2:22 conditioning. Unfortunately in 2006 I peaked a month too soon, got injured, and was not in that shape when I ran my target race (2:28 pretty much running to finish after 4-5 miles in).
They tightened the standard to 2:19, and even under the best of circumstances I doubt I have that extra 3 minutes in me. I could not break 34:00 10K in college, 6 years later I got sub-31....I cannot imagine what it would take to get another minute off and parallel a 2:19 marathon. 2:22 was ambitioius enough.
Coupled with that, I could train my tail off in grad school. My wife was understanding. Now working full-time as the breadwinner, and having to be Daddy when I go home, I just don't have the capacity to do that any more. I'm trying to up my mileage right now and finding it very, VERY hard to get in 70 mpw much less 90-110. And consistency for months on end, forget it!
Trent, thanks for the article. Turns out I am familiar with the condition after all, I thought it might be something different. It sounds like I could blow my healthcare budget getting a diagnosis I can't do anything about. I'm going to load up on iron and vitamins and see what happens.
The wierd thing is that running is what overcomes the fatigue. At least for a few hours, if I can force myself to get out for a run I will feel better and the fatigue will go away....

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand